Blood pressure and mortality during an up to 32-year follow-up

Background Elevated blood pressure is an established risk factor of cardiov ascular diseases, but there is a constant debate whether the association is continuous or with a threshold, Methods During the 1960s (1964 onwards), 3267 initially healthy male busine ss executives (born 1919-1934) participated in voluntary health check-ups w ith measurements of cardiovascular disease risk factors, At baseline none o f the men were on antihypertensive medication, Mortality follow-up was perf ormed using national registers up to 31 December, 1995, Follow-up total and cardiovascular mortality was related to systolic (by 10 mmHg) and diastoli c (by 5 mmHg, Korotkoff's 4th phase) blood pressure at baseline, Analyses w ere adjusted for age, body mass index, smoking and serum cholesterol. Results During an up to 32-year follow-up, there were 701 deaths, 234 (33.4 %) of them due to coronary heart disease, 49 (7.0%) to stroke, 42 (6.0%) to other cardiovascular diseases and 204 (29.1%) to cancer, Total mortality c urves of the whole cohort (all age groups) were flat until 131-140 mmHg (sy stolic) and 81-85 (diastolic) and increased thereafter. Among men who smoke d and had baseline serum cholesterol > 6.5 mmol/l (n = 986), the risk of de ath increased progressively with systolic blood pressure, whereas among non -smoking normocholesterolaemic men (n = 504) the association was J-shaped, i.e. higher mortality at less than or equal to 110 mmHg than between 111-15 0 mmHg and a more consistent rise from 151-160 mmHg, The curves were essent ially similar for cardiovascular mortality. The results were supported by a nalyses where major cardiovascular risk factors were controlled. Conclusion During a truly long-term follow-up, the relationship between sys tolic blood pressure and mortality was initially flat up to 131-140 mmHg al though a linear relationship is suggested in men with other cardiovascular risk factors, (C) 2001 Lippincott Williams & Wilkins.